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目的在大样本群体中探讨不同糖耐量状态孕妇血脂谱及其围生结局,并寻找巨大儿发生的独立危险因素。方法 50g口服葡萄糖筛查试验(GCT)1hPG≥7.8mmol/L的孕妇共2069例,按100g OGTT结果分为NGT(n=911)、IGT(n=422)和GDM(n=736)3组,并测定3组HbA_1c、TG、TC、LDL-C、HDL-C水平,以上指标均在24～28孕周获得。结果 (1)不同糖耐量状态的孕妇TG、TC、LDL-C、HDL C均较非孕参考范围明显升高。从NGT→IGT→GDM组,TG逐步上升(P<0.01),HDLC逐步下降(P<0.01),TC和LDL-C无统计学差异。(2)经过对血糖的严格干预后,3组的孕期体重增加,新生儿体重无差异,然而巨大儿的发生率在GDM和IGT组仍明显高于NGT组(14.1%,13.1%vs6.6%,P<0.01)。(3)二项分类Logistic回归分析发现OGTT中的FPG(OR=2.98,95%CI 1.63～5.48,P<0.01)、孕期体重增加(OR=1.12,95%CI 1.06～1.19,P<0.01)为巨大儿发生的独立危险因素,而HDL-C为独立保护因素(OR=0.41,95%CI 0.20～0.86,P<0.05)。结论妊娠时,血脂各组分较非孕状态明显升高,从NGT→IGT→GDM,TG逐步上升而HDL-C逐步下降。即使经过血糖的严格干预,巨大儿的发生率并不能降低到NGT组水平。FPG水平和孕重增加是巨大儿发生的独立危险因素,而HDL-C是保护因素。
OBJECTIVE: To explore the serum lipid profile and its perinatal outcome in pregnant women with different glucose tolerance status in large sample population and to find out the independent risk factors for macrosomia. Methods A total of 2069 pregnant women with a 50g oral glucose screening test (GCT) ≥7.8mmol / L were divided into 3 groups: NGT (n = 911), IGT (n = 422) and GDM (n = 736) according to 100g OGTT results , And the levels of HbA1c, TG, TC, LDL-C and HDL-C in 3 groups were measured. The above indexes were all obtained in gestational weeks 24-28. Results (1) TG, TC, LDL-C and HDL C in pregnant women with different glucose tolerance status were significantly higher than those in non-pregnant reference group. From NGT to IGT to GDM, TG gradually increased (P <0.01), HDLC decreased gradually (P <0.01), and there was no significant difference between TC and LDL-C. (2) The weight of newborns was no significant difference between the three groups after gestational diabetes intervention, however, the incidence of macrosomia in GDM group and IGT group was still significantly higher than that in NGT group (14.1%, 13.1% vs6.6 %, P <0.01). (3) Logistic regression analysis showed that FPG in OGTT (OR = 2.98, 95% CI 1.63-5.48, P <0.01) and weight gain during pregnancy (OR = 1.12, 95% CI 1.06-1.19, P <0.01) HDL-C was an independent risk factor for macrosomia (OR = 0.41, 95% CI 0.20-0.86, P <0.05). Conclusion During pregnancy, the components of blood lipids were significantly higher than those of non-pregnant rats, gradually increasing from NGT → IGT → GDM, TG and HDL-C gradually decreased. Even after strict intervention with blood glucose, the incidence of macrosomia does not decrease to the level of NGT. FPG levels and increased pregnancy weight are independent risk factors for macrosomia, whereas HDL-C is a protective factor.